Cancer of the gallbladder, an uncommon cancer, is a disease in which cancer cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. Bile, a fluid made by the liver, is stored in the gallbladder. When food is being broken down (digested) in the stomach and the intestines, bile is released from the gallbladder through a tube called the bile duct that connects the gallbladder and liver to the first part of the small intestine. The bile helps to digest fat.

Cancer of the gallbladder is more common in women than in men. It is also more common in people who have hard clusters of material in their gallbladder (gallstones).

Cancer of the gallbladder is hard to find (diagnose) because the gallbladder is hidden behind other organs in the abdomen. Cancer of the gallbladder is sometimes found after the gallbladder is removed for other reasons. The symptoms of cancer of the gallbladder may be like other diseases of the gallbladder, such as gallstones or infection, and there may be no symptoms in the early stages. A doctor should be seen if the following symptoms persist:

• Pain above the stomach
• Loss of weight without trying
• Fever
• Yellowing of the skin (jaundice)

If there are symptoms, a doctor may order x-rays and other tests to see what is wrong. However, usually the cancer cannot be found unless the patient has surgery. During surgery, a cut is made in the abdomen so that the gallbladder and other nearby organs and tissues can be examined.

The chance of recovery and choice of treatment depend on the stage of cancer (whether it is just in the gallbladder or has spread to other places) and on the patient’s general health.

Stage Explanation

Stages of cancer of the gallbladder

Once cancer of the gallbladder is found, more tests will be done to find out if cancer cells have spread to other parts of the body. A doctor needs to know the stage to plan treatment. The following stages are used for cancer of the gallbladder:

Localized

Cancer is found only in the tissues that make up the wall of the gallbladder, and it can be removed completely in an operation.

Unresectable

All of the cancer cannot be removed in an operation. Cancer has spread to the tissues around the gallbladder, such as the liver, stomach, pancreas, or intestine and/or to lymph nodes in the area. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the gallbladder or in another part of the body.

How cancer of the gallbladder is treated

There are treatments for all patients with cancer of the gallbladder. Three treatments are used:

• Surgery (taking out the cancer or relieving symptoms of the cancer in an operation)
• Radiation therapy (using high-dose x-rays to kill cancer cells)
• Chemotherapy (using drugs to kill cancer)

Surgery is a common treatment of cancer of the gallbladder if it has not spread to surrounding tissues. The doctor may take out the gallbladder in an operation called a cholecystectomy. Part of the liver around the gallbladder and lymph nodes in the abdomen may also be removed.

If the cancer has spread and cannot be removed, the doctor may do surgery to relieve symptoms. If the cancer is blocking the bile ducts and bile builds up in the gallbladder, the doctor may do surgery to go around (bypass) the cancer. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or other procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. During these procedures, the doctor may place the catheter so that it drains through a tube to the outside of the body or so that it goes around the blocked area and drains the bile into the small intestine.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumours. Radiation for gallbladder cancer usually comes from a machine outside the body (external-beam radiation therapy). Radiation may be used alone or in addition to surgery.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for cancer of the gallbladder is usually put into the body by a needle inserted into a vein. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the gallbladder. Chemotherapy or other drugs may be given with radiation therapy to make cancer cells more sensitive to radiation (radiosensitizers).

Treatment by stage

Treatments for cancer of the gallbladder depend on the stage of the disease and the patient’s general health.

Localized Gallbladder Cancer

Treatment may be one of the following:

1. Surgery to remove the gallbladder and some of the tissues around it (cholecystectomy).
2. External-beam radiation therapy with or without chemotherapy, possibly followed by surgery.
3. A clinical trial evaluating radiation therapy plus chemotherapy or drugs to make the cancer cells more sensitive to radiation (radiosensitizers).

Unresectable Gallbladder Cancer

Treatment may be one of the following:

1. Surgery or other procedures to relieve symptoms.
2. Surgery to bypass the obstructed ducts of the gallbladder.
3. External-beam radiation therapy with or without chemotherapy possibly followed by surgery.
4. Chemotherapy to relieve symptoms. Clinical trials are testing new chemotherapy drugs.
5. A clinical trial evaluating radiation therapy plus chemotherapy or drugs to make the cancer cells more sensitive to radiation (radiosensitizers).

Recurrent Gallbladder Cancer

Treatment for recurrent cancer of the gallbladder depends on the type of treatment the patient received before, the place where the cancer has recurred and other facts about the cancer, and the patient’s general health. The patient may wish to consider taking part in a clinical trial.

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